Cardiopulmonary Bypass and Management

Cardiopulmonary bypass (CPB) is an imminent element of today's cardiac surgery. Major differences not only exist in setup and materials, but also in management strategies. The phases of CPB are similar to the adult, but the effects on the body and the physiological disturbances are far more pertinent. Hemodilution is the major hematologic disturbance that leads to coagulation deficiencies and challenges the oxygen transport capacities of the body. Hemodilution and the membrane oxygenator itself change the pharmacokinetics and pharmacodynamics of most anesthetics in use. Physiological limits are permanently reached during pediatric cardiac surgery and are most obvious during the care of Jehova's Witness patients. Lower body temperatures than in adults are routinely used which influences acid base management. Special techniques applied are deep hypothermic circulatory arrest and selective cerebral perfusion which enable a broad spectrum of today's congenital cardiac surgery. Despite technical advances widespread effects on the body systems remain and these changes can prolong the postoperative course and endanger a primarily successful repair.